The Lancet

Condividi contenuti
The Lancet RSS feed.
Aggiornato: 10 ore 16 min fa

[Editorial] Fetal medicine: past, present, and future

%age fa
Two Articles published in this week's issue highlight the potential of whole-exome sequencing to increase the possibility of a genetic diagnosis when fetal structural anomalies are detected. In both studies, fetuses were prospectively included if structural anomalies were detected through routine prenatal ultrasound and if no aneuploidy or large copy number variants were confirmed. Fetal and parental whole-exome sequencing showed clinically significant genetic variants in 8·5% of fetuses in one study and 10·3% in the other.

[Editorial] Closing the gap for Aboriginal health

%age fa
On Feb 14, the last Closing the Gap report on Aboriginal people in Australia was released. In a feeling of déjà vu, the 11th annual report again showed little progress. In 2018, just two of seven targets designed to narrow inequalities for Aboriginal and Torres Strait Islander peoples on health, education, and employment were on track. Ten years after the initiative was launched, life expectancy at birth is 71·6 years for Indigenous men and 75·6 years for Indigenous women, a massive gap of 8·6 years and 7·8 years, respectively, compared with non-Indigenous Australians.

[Editorial] Dietary supplement regulation: FDA's bitter pill

%age fa
The use of dietary supplements has risen precipitously in the past decade, with the fastest growth in Asia Pacific, but also substantially in Europe and North America. At least three-quarters of Americans report regularly using dietary supplements, most commonly reporting taking multivitamins. That translates into an exceedingly lucrative industry, with an estimated US$40 billion market in the USA alone.

[Comment] Inclusivity and equity in human microbiome research

%age fa
The microbiome is an ancient and integral regulator of human physiology.1 However, population and geographical differences, including in diet, environment, and cultural and clinical practices, have given rise to regional variations in composition.2 In turn, these variations are reflected in rates of morbidity and mortality for microbiome-influenced conditions. For example, the geographical distributions of immunogenic bacteria that metabolise human milk oligosaccharides have been linked to patterns of childhood autoimmune diseases,3 and the relative prevalence of bacteria responsible for the metabolism of dietary fat and fibre has been shown to contribute to differences in colon cancer incidence in migrants to new cultures.

[Comment] Offline: General practice—changing the laws of nature

%age fa
Julian Tudor Hart (1927–2018): “The availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.” He wrote his famous Lancet paper on the inverse care law from the Glyncorrwg Health Centre in Port Talbot, Wales, in 1971. His death last year was the motivation for an inspirational gathering of 200 people in Glasgow last week to discuss the exceptional potential of general practice.

[World Report] Hospital attack in anglophone Cameroon kills four patients

%age fa
The attack on the hospital comes as tensions run high between the Cameroonian Government and the anglophone Cameroon separatists. Paul Adepoju reports.

[World Report] Plasma suspected to be contaminated causes fear in China

%age fa
Officials now say that there is no detectable HIV antibody in the suspect plasma batch, but no explanation has been offered to explain original test results. Xun Yuan reports.

[World Report] Lebanon's new Health Minister

%age fa
Jamil Jabak was put forward by Hezbollah, which insists its choice of health minister in newly-formed government will serve all Lebanese communities. Sharmila Devi reports.

[Perspectives] Susan La Flesche Picotte: a doctor who spanned two cultures

%age fa
As a child, she accompanied her father and the Omaha people on buffalo hunts. As an adult, she saw their traditional way of life disappearing, provided medical care to her community, and acted as an advocate for the Omaha people's rights over land. Susan La Flesche Picotte, the first Native American woman to qualify as a doctor in the USA, learned the ways of the dominant white population while never rejecting her Omaha identity.

[Perspectives] Giving a voice to postnatal mental health

%age fa
The setting is a single bench on an empty railway platform. We meet Em here, as she sobs into the darkness. A train passes. The only other presence is that of a baby in a car seat. “Whose baby is this?”, Em asks. Rattled, a powerful one-woman play, has writer and actor Rachel Harper explore what brought Em to this point.

[Perspectives] Illustrating the body

%age fa
“The figure was that of a man without a skin; with every vein, artery, muscle, every fibre and tendon and tissue of the human frame represented in minute detail…it was a hideous thing, and yet there was a fascination about it some where.” So writes Mark Twain in Innocents Abroad, of the famous Milanese statue from 1562 of flayed St Bartholomew. Anatomical art is a subject of endless fascination, and is the theme of Under the Skin: Illustrating the Human Body, an exhibition at the UK's Royal College of Physicians (RCP) displaying books, artworks, and objects from the their impressive collections.

[Perspectives] Vesalius annotations and the rise of early modern medicine

%age fa
Next time you are in a library, open a random 16th-century book. There is a good chance that it contains a number of early handwritten annotations, underlinings, and haphazard jottings. Most books printed before 1600 were marked up by their readers in such a manner. A careful study of these annotations can reveal how readers responded to books, and what impact printed books had on the early modern world. We can examine how studiously the composer Johann Sebastian Bach read his Bible, and how much the protestant reformer Martin Luther disliked his contemporary author Erasmus of Rotterdam, writing “You are crazy” on the margins of Erasmus' edition of the New Testament.

[Obituary] Jasper Evan Sadler

%age fa
Haematologist renowned for work on blood clotting disorders. He was born in Huntington, WV, USA, on Nov 9, 1951, and died with a neurodegenerative disease in Clayton, MI, USA, on Dec 13, 2018, aged 67 years.

[Correspondence] Gender bias in academia

%age fa
We have previously discussed how societal-level structures might influence scientific publishing processes.1 We disagree with Jason Boynton and colleagues' assessment (Oct 27, 2018, p 1514)2 of the evidence we presented. Boynton and colleagues expressed concern that we did not establish causation for the processes through which women are disadvantaged in generating and publishing knowledge. It is outside the scope of a commentary to test for causation, and thus make causal claims. Additionally, the causes of gender disparities are complex and include both distal and proximal factors.

[Correspondence] Gender bias in academia

%age fa
I agree emphatically with Jason Boynton and colleagues'1 call for intellectual rigour and inclusion of all important facts when considering questions of gender bias in academia. I also agree with their concerns about implicit bias testing and training. Unfortunately, their Correspondence is flawed.

[Correspondence] Abortion in Argentina

%age fa
In writing about the failed abortion bill in Argentina, the Editors (Aug 18, 2018, p 532)1 missed the opportunity to provide insight or viable solutions for Argentinian women in the wake of these events. Despite Argentina's 2010 reproductive health law that guarantees universal access to barrier, medical, and surgical contraception, women fail to receive these services. According to official figures from 2010,2 up to half a million abortions are induced each year. In 2016, abortion was recorded as the cause of about 18% of maternal deaths.

[Correspondence] Abortion in Argentina

%age fa
The emotive and well-written Editorial1 about the failed abortion bill in Argentina requires an important clarification. The Catholic Church is not opposed to women's rights but rather opposes abortion. This is a significant distinction. The Catholic Agency for Overseas Development (CAFOD) is an international Catholic charity dedicated to the advancement of women's rights and gender equality in South America and other parts of the world. Support for abortion is not synonymous with the championing of women's rights, as suggested in the Editorial.

[Correspondence] Abortion in Argentina

%age fa
The Editors 1 state that “unsafe abortion is a leading cause of maternal death [in Argentina]”. With all due respect, this statement does not fit the facts. In 2016, the last year for which statistics are available, 245 maternal deaths occurred in Argentina.2 Direct obstetric causes of maternal mortality accounted for 135 deaths, indirect obstetric causes accounted for 67 deaths, and pregnancy ending in abortion accounted for 43 deaths. This last figure is a broad category that includes ectopic pregnancies, molar pregnancies, spontaneous abortions, and procured abortions.

[Department of Error] Department of Error

%age fa
Schadendorf D, van Akkooi ACJ, Berking C, et al. Melanoma. Lancet 2018; 392: 971–84—In this Seminar, figure 2 incorrectly contained only male incidence trends in both the panel for men (left) and women (right). The data in the right-hand panel (women) have been replaced with the incidence trends for women. This correction has been made to the online version as of Feb 21, 2019.

[Department of Error] Department of Error

%age fa
Garas G, Cingolani I, Panzarasa P, Darzi A, Athanasiou T. Beyond IDEAL: the importance of surgical innovation metrics. Lancet 2019; 393: 315—In this Correspondence, the affiliations should read “Department of Surgery and Cancer, St Mary's Hospital (GG, AD, TA), and Centre for Health Policy (IC), Imperial College London, London W2 1NY, UK; and School of Business and Management, Queen Mary University of London, London, UK (PP)”. This correction has been made as of Feb 21, 2019.